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“There aren’t women who have children and women who have abortions”

Half of the women who visited the province’s only abortion clinic over the past year already have children, says the clinic’s owner.

Of the more than 800 procedures performed at the Athena Health Centre in St. John’s last year, the fact that 50 per cent of the patients are already mothers is an indication financial status is a strong determinant for many in their decision to abort a pregnancy, Rolanda Ryan explains.

“When these women come in they have one child, two children, three children, four children, and they’re looking at an unplanned pregnancy; financially it can be devastating for the entire family for them to bring another person into that household,” she says. “So I mean the women who come here never want to be here but for their own individual reasons they make this decision and it is truly what’s in their best interest at that moment in time.”

Incoming “anti-choice” Premier

Ryan says she’s “disappointed” to learn Newfoundland and Labrador Premier-in-waiting Frank Coleman participates in an annual right-to-life protest in Corner Brook, and that despite his claim last Friday that he will separate his private life from his public life, by virtue of being in a position of power and influence his now public anti-choice beliefs could be “discouraging” for women struggling with the decision on whether or not to terminate an unwanted pregnancy.

Frank Coleman.

“I do not seek to impose my views on anyone and truly respect the gift of free will we are all afforded,” Coleman said in a written statement on Friday.

But Ryan doesn’t agree that protesting a woman’s right to choose does not equate to imposing one’s view on others, or to respecting women’s free will.

“It’s not a matter of private opinion that makes you go to these rallies,” she says. “It’s actually a matter of wanting to have an impact, wanting to make a political statement that you are either actively pro-choice or anti-choice. And by marching for the anti-choice movement basically you’re hoping that government will hear you, [that] it will have an impact on policy, on funding.”

Each year about 1,000 abortions are performed in St. John’s—70 to 80 per cent of them at Athena—and the circumstances surrounding each woman’s decision are unique, Ryan explains.

“The reasons people bring themselves into the clinic are as individual as the women themselves,” she says, explaining many of the women who visit her clinic were in fact anti-choice until faced with an unwanted pregnancy themselves.

“Nobody ever wants to be here, nobody ever plans to be here…but when you’re faced with a crisis—and it truly is a crisis in a lot of these women’s lives—of an unwanted pregnancy and either for financial reasons, emotional reasons, psychological reasons, abusive relationship reasons — there’s thousands of reasons why women come in here, and whatever those reasons are, clearly the woman has put significant thought into what’s in the best interest for her and her family.

“There aren’t women who have children and women who have abortions. Oftentimes these are the exact same women at different points and in different circumstances in their life, and they’re forced to make a decision…that seems to them to be the one that is the best for them at that moment in time.”

Abortion services in NL

A Supreme Court of Canada decision 25 years ago legalized abortion and made the country a global leader in women’s reproductive rights. Henry Morgentaler, the Montreal doctor who famously challenged Canada’s anti-abortion law on constitutional grounds, opened abortion clinics in Quebec, Ontario, New Brunswick, Nova Scotia and Newfoundland. The St. John’s clinic opened in October 1990 and was taken over by Ryan in 2010, she says, as part of the Morgentaler family’s decision to put ownership of the clinics into the hands of current staff and doctors.

But the right-to-life movement in Newfoundland and elsewhere has persistently protested the law, doctors and clinics that offer the medical service, and at times even patients as they arrive and leave clinics.

According to a 1998 article in the Canadian Medical Association Journal, from the time the St. John’s Morgentaler clinic opened until 1993 the out-of-pocket cost for a woman having an abortion ranged from $400-$750, despite the fact abortion was covered by the Canada Health Act as a medically necessary procedure. In ’93, however, the province began paying the salaries of physicians at the Morgentaler clinic, enabling the clinic to reduce its fees. Then, in 1995, the federal government began forcing the provinces to cover the full cost of abortions for those eligible for provincial health care, and by 1998 the Government of Newfoundland was fully funding the medical service. The cost to the province today is about $1,000 per procedure.

Over the past two decades there has been no real threat to funding for abortion services in the province, and Coleman’s statement on Friday indicates he is not seriously contemplating tampering with the existing policies.

“We have to believe he will be true to his word, and I certainly hope he will,” says Ryan.

Though abortion procedures are also done at the Health Sciences Centre in St. John’s most women still choose Ryan’s clinic over the hospital.

To have an abortion at the hospital a woman must be referred by a physician, whereas she can self-refer to have the procedure done by a doctor at the Athena clinic. When a woman visits the clinic, Ryan says, she meets with a counsellor whose job is to make sure the woman is aware of all her options and is not being coerced by anyone into having an abortion.

“If the counselor feels that the person isn’t ready for this, that she’s not sure of her decision, then the counselor won’t let it progress beyond that [and] she will stop the abortion from happening that day,” she explains. “So in some cases that means the woman leaves, rebooks the appointment and comes back a week or two later when she’s given more thought to it, and in some cases it means the woman leaves and never comes back.

“So we want to make sure that when we do this it’s because it’s what the woman wants to have done, not because somebody’s forcing her into doing this.”

Ryan believes another factor in some women’s decision on where to go for the procedure is the hospital’s use of the MEDITECH system, “which means your health information gets into your electronic health profile,” she explains.

“For some women, especially those we find who work at the hospital — they don’t want that information in their electronic health record. And for other women that doesn’t matter — they strongly believe in their right to choice and they believe that their health is their information and that people shouldn’t be accessing their information.”

Abortions performed in the hospital also require women to stay overnight, while procedures done at Athena are same-day.

[W]hat they need is compassionate care, they need to be treated with respect, they need to be valued as human beings. They need to know that when they walk out the door that they’re valued, that they’re loved, that they’re important. – Rolanda Ryan

“It comes down to basically personal choice and some women just find one day more convenient than two, but there’s other women who certainly would rather be in a hospital setting,” Ryan explains. “And we work very well with the Health Sciences, we have at many times referred patients to them and there have been points where they have given patients our number and referred patients to us. So both places provide very safe services … [and there are] incredibly experienced staff in both places, both doctors and nurses, and I think whatever the woman chooses, whatever her comfort level is, I think she will be given excellent care.”

Still, with only the Health Sciences Centre and Athena clinic in St. John’s, women living on the West Coast, Northern Peninsula, Labrador and other remote parts of the province are faced with a huge burden in accessing abortion services.

For women who are employed, and for students, “obviously there’s a big financial cost to them to get in, whether they drive or fly,” says Ryan. “And for women on social [assistance] it’s a different issue because social services will pay for their transportation and accommodation. But for the women who are self-employed, or students, or employed in any other capacity basically, they have to pay the costs.

“So it is a time commitment, it’s a financial commitment, and certainly for the women from Labrador who aren’t covered by any government via social services…[or] who are working or students—in the winter months the ferry doesn’t cross so they have to fly in and out, so it’s even more expensive again for those women.”

Students from other provinces who are studying in Newfoundland and Labrador are also vulnerable to inter-provincial bureaucratic policy conflicts.

“There’s no reciprocal billing, which means that women from another province can’t get funded. So if there’s a university student here from another province they can’t go to us or to the hospital and [have their abortion covered] because there’s no reciprocal billing between provinces.”

Despite advances in women’s health and reproductive rights in recent years, Athena Health Services could soon be the only private abortion clinic in all of Atlantic Canada. Earlier this month the Morgentaler Clinic in Fredericton, N.B. announced it will be closing its doors in July after struggling through a 20-year battle with the province for funding. The clinic’s closure is likely to force women in New Brunswick, a province many argue has antiquated abortion laws, to travel to the nearest clinic in Montreal.

A New Brunswick law requires women seeking to have an abortion at one of two hospitals in the province to first acquire referrals from two doctors who certify the procedure as medically necessary.

Ryan thinks the New Brunswick clinic still has a chance of keeping its doors open though if there’s enough public support and political will, but she says if anything similar were to happen here “there would be a big outcry”.

“We’re very fortunate in Newfoundland — [abortion] has been a covered service since 1998 and I think a lot of the generation coming through the doors now, they don’t remember… the big fight that happened to get it here in 1990. So for women in their 20s it’s always been an option for them, it’s always been something that they grew up knowing if they did have an unintended pregnancy, it was one of the choices that was available to them,” she says. “But I do believe that there’s a strong feminist youth in our province and I think that if abortion was ever considered for defunding I do think there would be a big outcry. I realize there’s a big anti-choice movement in the province as well, but I do believe that as with the rest of Canada that the majority of people do believe in a woman’s right to choose and I think there would be a big backlash if that was ever examined for delisting from provincial funding.”

Shame and the persistence of anti-choice culture

Women’s struggle for reproductive justice doesn’t begin and end with government funding and access to abortion clinics though.

Ryan says there is still a substantial anti-abortion culture within the province’s medical community.

“We have women who have gone to their own family doctors to discuss their unintended pregnancy and been chastised by their own family doctors. We’ve had family doctors spreading false information,” she explains.

“We’ve had doctors who’ve prayed over patients when a patient has even brought up the word abortion. So there are physicians like it, there are family and friends who do that to women. We’ve had women come in here and the person who came in with them was anti-choice, sitting down here berating the patient for her decision while she’s actually here.”

And in light of Coleman’s admission that he too is anti-choice, Ryan wonders if those who have never been in the situation but still protest a women’s right to choose will ever understand.

“Not just Mr. Coleman but all the anti-choice people, if they could just take a minute and envision what would happen…if their daughter, their granddaughter, their sister, their mother, somebody they know, was a victim of sexual assault and did have an unintentional pregnancy. Would they then be able to say to the woman, ‘You should go through that pregnancy and put it up for adoption’? I mean, that’s revictimizing the woman, having her suffer through that for nine months, you know? And you don’t ever get over that — it’s one of those traumas that you just want to deal with and try and resolve it.

“That’s an extreme case, but every woman who comes in here has a story and a lot of those stories are absolutely heart-breaking. And for people to have an opinion when they’ve never ever been in that situation, or never sat down and had a discussion with a woman who’s in a crisis, to realize that the kind of thing you can do is to relieve her of the crisis and to help her when she’s really desperate for help. I guess I’ve always been able to empathize with people no matter what their situation is and I find it hard that people can’t even imagine that, imagine talking to somebody in that situation and realizing that…what they need is compassionate care, they need to be treated with respect, they need to be valued as human beings. They need to know that when they walk out the door that they’re valued, that they’re loved, that they’re important.

“To stand in front of our clinic or to get on the news or to do anything that shames these women is absolutely — it’s abuse, it’s abusive to the woman, and it’s so uncalled for because you do not know what that woman is going through and in most cases you can’t even begin to imagine.”

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